Child Supervision and Burn Outcome among Admitted Patients at Major Trauma Hospitals in the Gambia

Burn-related injuries are a significant burden in children, particularly in low- and middle-income countries (LMICs), where more than 90% of burn-related pediatric deaths occur. Lack of adult supervision of children is a major risk for pediatric burn injuries. The goal of this paper was to examine the general characteristics of burns and identify burn injury outcomes among adult-supervised children compared to those who were not supervised. The study examined burn injury and clinical characteristics among all burn patients admitted to two trauma hospitals in The Gambia, West Africa. At intake in the emergency room, the treating physician or nurse determined the need for admission based on body surface area burned (BSAB), depth of burn, and other clinical considerations such as co-occurring injuries and co-morbidities. During the study period of 1 April 2014 through 31 October 2016, 105 burn patients were admitted and data were collected by the treating physician for all of them. Information about supervision was only asked for children aged five years or less. More than half (51%) of the burn patients were children under 18 years, and 22% were under 5 years. Among children under five, most (86.4%) were supervised by an adult at the time of burn event. Of the 19 supervised children, 16 (84.2%) had body area surface burned (BSAB) of less than 20%. Two of the three children without adult supervision at the time of burn event had BSAB ≥ 20%. Overall, 59% of the patients had 20% + BSAB. Females (aOR = 1.25; 95% CI = 0.43-3.62), those burned in rural towns and villages (aOR = 2.29; 95% CI = 0.69-7.57), or burned by fire or flames (aOR = 1.47; 95% CI = 0.51-4.23) had increased odds of having a BSAB ≥ 20%, although these differences were not statistically significant. Children 0-5 years or 5-18 years (aOR = 0.04, 95% CI = 0.01-0.17; aOR = 0.07, 95% CI = 0.02-0.23, respectively) were less likely to have BSAB ≥ 20% than adults. Those burned in a rural location (aOR = 9.23, 95% CI = 2.30-37.12) or by fire or flames (aOR = 6.09, 95% CI = 1.55-23.97) were more likely to die. Children 0-5 years or 5-18 years (aOR = 0.2, 95% CI = 0.03-1.18; aOR = 0.38; 95% CI = 0.11-1.570, respectively) were less likely to die. Children constitute a significant proportion of admitted burn patients, and most of them were supervised at the time of the burn event. Supervised children (compared to unsupervised children) had less severe burns. Programs that focus on burn prevention at all levels including child supervision could increase awareness and reduce burns or their severity. Programs need to be designed and evaluated with focus on the child development stage and the leading causes of burns by age group.